Adenocarcinoma of the prostate with neuroendocrine differentiation

Last revised by Dr Joachim Feger on 11 Feb 2022

Adenocarcinoma of the prostate with neuroendocrine differentiation is a malignant neuroendocrine tumor of the prostate which only differs from acinar or ductal adenocarcinoma on immunohistochemistry staining.

The diagnosis of adenocarcinoma of the prostate with neuroendocrine differentiation is based on histological and immunohistochemical features.

Adenocarcinoma of the prostate with neuroendocrine differentiation is an acinar or ductal adenocarcinoma that does not feature any typical neuroendocrine morphology as e.g. nuclear molding in small cell carcinoma or peripheral palisading in prostatic large cell neuroendocrine carcinoma but is characterized by the positivity of one of three neuroendocrine markers chromogranin A, synaptophysin or CD56 1,2.

Histologically usual adenocarcinoma of the prostate with neuroendocrine differentiation is characterized by the typical features of adenocarcinoma including 3

  • neoplastic proliferation of luminal cells
  • loss of basal cells
  • neuroendocrine cells on immunohistochemistry stains

Immunohistochemistry stains are usually positive for at least one neuroendocrine marker as chromogranin A, synaptophysin or CD56 2. Prostate-specific antigen (PSA) is usually positive in the adenocarcinoma and variably positive in the neuroendocrine cells 2.

Imaging features of adenocarcinoma of the prostate with neuroendocrine differentiation are that of typical prostate adenocarcinoma.

The prognosis and treatment of adenocarcinoma of the prostate with neuroendocrine differentiation are not different from normal prostate adenocarcinoma 3,4 and therefore immunohistochemistry for the detection of neuroendocrine cells is not recommended in an otherwise typical adenocarcinoma of the prostate 2.

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